Patient selection: AIDS with cryptococcal infection
Refractory cryptococcosis refers to an infection that does respond to appropriate antifungal therapy.
Relapsing cryptococcosis refers to an infection that recurs after an initial response to antifungal therapy.
A cure was defined as control of the cryptococcosis without relapse during the follow-up period of at least 2 years.
Risk factors for refractory or relapsing infections:
(1) infection with C. neoformans var grubii, sex type alpha, genotype VNI
(2) chronic liver disease (viral hepatitis, alcoholic, other)
(3) leukopenia (< 2,000 per µL)
Patients with refractory or relapsing infection tend to have disseminated infection with cryptococcemia and extensive CNS involvement.
These patients require more aggressive management:
(1) The isolate should have antifungal susceptibility performed.
(2) Aggressive antifungal therapy is needed, and the patient needs to be compliant.
(3) The patient should be followed for early signs of relapse.
(4) Therapy to improve immunity and other host defenses should be started.
